New horizons for stem-cell science 
By Ijaz Ahmad Rao 

The stem-cell technique is a tool of biotechnology and genetic engineering which has recently generated tremendous excitement among medical and research communities who hope to benefit from this technology.

Stem cells are immature cells that can develop into almost any of the 216 different kinds of cells in the human body. All of our bodies contain stem cells, but for medical purposes we mainly consider stem cells from two sources: embryonic or non-embryonic.

Both types of stem cells are undifferentiated and developmentally flexible. Embryonic stem cells come from embryos. In order to collect these cells, the living human embryo must be destroyed.

Non-embryonic stem cells also called "adult stem cells" come from a variety of sources, including skin cells, bone marrow, placenta, umbilical cord blood, brain cells and body fat, however, no human lives are destroyed in harvesting adult stem cells.

In this article we focus on adult stem cells because these cells (specially from cord blood) are abundantly available in all parts of Pakistan.Secondly, it will also be examined as to how we can effectively combat our health problems with this emerging technology.

Cord blood, which is the remaining blood from your baby's umbilical cord and placenta after birth is loaded with our "stem cells." A few years ago, cord blood was simply discarded as medical waste after birth. Although, stem cell research began as early as the 1950s, when scientists began experimenting with mice.

Mouse embryonic stem cells were first isolated and successfully cultivated in 1981 by a group led by Martin Evans at the University of Cambridge. But in the 1970s medical researchers discovered that human umbilical cord blood contained the same kind of stem cells found in bone marrow. Therefore, in 1988, doctors transplanted human umbilical cord blood into a 5-year-old boy suffering from Fanconi's anemia.

Years after the transplant, the boy is still alive and seems to be cured of his disease based on this and other successful transplants, doctors and medical researchers began to collect, freeze and store cord blood units (CBUs) at cord banks throughout the world.

Today there were approximately 35,000 CBUs collected and frozen for use worldwide, and approximately 800 unrelated donor and 200 related (sibling) donor cord blood transplants had been performed.

Unfortunately, in our country, we have not been able to setup a single cord blood storage unit for our future treatments and we just continue to throw-away this important natural gift. It is worth mentioning that in Western countries, the cost to store cord blood at commercial bank is very high, the initial cost ranges from $200 to $1,500, plus an annual storage fee of $50 to $100, however, in Pakistan, it could be available for much lower cost.

In Pakistan, adult stem cells have been successfully used for the treatment of heart diseases (patients suffering from heart failure will be able to "re-grow" muscle and blood vessels in their own failing organs) and liver-related diseases which result either due to Hepatitis B or C.

Millions of people in Pakistan suffer from diseases such as thalassaemia, leukaemia, immune deficiency and other types of anemia. It is hoped that stem cells can be grown to substitute dead or diseased cells in a number of organs. If a person's blood stem cells become damaged due to diseases, cancer, or leukemia, the only hope for a cure is a blood stem cell transplant. This replaces the patient's diseased cells with healthy new stem cells from HLA-matched sibling donor or voluntary unrelated donor.

Transplanted stem cells must be HLA-match or very good molecular HLA-loci match the patient's cells to reduce the risk of rejection or Graft-Versus-Host Disease (GVHD).

Currently there is a lack of voluntary Asian donors for blood, bone marrow and organ transplantation. An Asian register of voluntary donors would be helpful for many patients with cancer and genetic diseases.

It is worth knowing that bone marrow transplantation depends on the presence of stem cells, which naturally re-populate the white and red blood cells and blood platelets. This is particularly crucial after cancer chemotherapy.

In July 2002, a leukaemia sufferer became the first adult in the UK to undergo a stem cell transplant using blood from a baby's umbilical cord. According to BBC report: "Stephen Knox, 31, underwent the treatment, previously only performed in the UK on children, after being given just months to live. His cancer went into remission."

Similarly, it is important to know that adult stem cells and mesenchymal cells are also used in regenerative medicine for bone, cartilage, muscle and cutaneous tissue regrowth. This could be employed in diseases such as brittle bone disease (Osteogenic imperfecta), non-healing compound bone fractures, Osteomyelitis and non-healing leg ulcers and wound healing.

Recently, for the first time in Pakistan's, Dr Manzoor H Mangi from The Royal London Hospital, UK, and Dr Rahim Bux Bhatti, amplified high-yield universal stem cells, and conducted clinical implantation of universal stem cells,osteogenic stem cells, mesenchymal stem cells and angiogenic stem cells at the Taluka Hospital Gambat, district Khairpur in Sindh. For the past 12 years, the patient was suffering impaired lower leg mobility due to non-healing bones, non-healing soft-tissue, impaired vascularity and non-healing cutaneous tissue. All the previous conventional treatments had proved ineffective. His only option was universal stem cell regenerative therapy and this proved successful. He has achieved 99 per cent healing with stem cell implantation and is in good health and fully mobile.It is important to note that now Dr Mangi and his team are planning to use adult stem cells to treat heart and liver patients in Pakistan.

In recent years, many researchers have concluded that it was wrongly speculative to believe that embryonic stem cells are better than adult stem cells. That's why excitement over adult stem cell research has increased dramatically because of successes in treating patients with these cells. Therapies using stem cells from sources such as bone marrow, umbilical cord blood, and the pancreas have proven successful in treating patients with Parkinson conditions.

In April 2002, a Los Angeles physician reported effectively treating the symptoms of a 59-year old male Parkinson's patient using the patient's own neuronal (brain) stem cells, reducing his symptoms by more than 80 per cent.

Any new treatments require extensive development and testing before they can be used for humans. Stem cell therapies do raise several safety issues must be consider and regulated by responsible bodies. There are many ethical issues in connection with umbilical cord blood banking that have need to be resolved like.

Who owns the cord blood sample? How is informed consent obtained from parents before harvesting cord blood? How should the obligation to notify parents and donor-children of the results of medical testing for infectious diseases and genetic information to be handled? How are privacy and confidentiality to be maintained? How will services for the harvesting of and access to umbilical cord blood be provided fairly?

Although embryonic stem cell is still more political and controversial topic in the first world, in May this year world's first national embryonic stem cell bank opened in London. The bank will accept embryonic cells as well as those from adults and fetuses for research purposes.

Opponents of research on embryonic stem cells have insisted that adult stem cells are a therapeutically superior and ethically more acceptable alternative. The government wishes to see responsible, ethical and high quality research using all sources of stem cells because this will offer the best chance of developing life saving treatments.

The government of Pakistan must look into this most needed and emerging technology as millions of Pakistani are effected by different kind of liver, heart or blood related disease, so we need to setup cord blood cell bank and there is need to motivate people to do investment.

For the sake of millions of patients in Pakistan, the government must provide incentives and create research centres to focus on new technologies. This way we can move forward to cost-effective and low-risk treatment as compared to organ transplantation.

Curtesy: The Dawn